AB1378 TITLE: BENEFIT OF GROUP MEDICAL VISITS IN THE MANAGEMENT OF FIBROMYALGIA
Authors: J. A. Pando, C. Welton, S. Griffith, O. Pando
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Fibromyalgia (FM) is a chronic condition characterized by widespread pain, fatigue, sleep disturbances and mood disorders (depression and anxiety)<sup>[1]</sup>. While there is no cure for Fibromyalgia, non-pharmacologic integrative modalities have been demonstrated to be effective improving clinical outcomes<sup>[3]</sup>. Group medical visits (GMV) have been used to integrate self-management skills and to deliver education to improve outcomes in patients with chronic diseases.<sup>[4-5]</sup> There are scant reports of the use of GMV in the management of patients with rheumatic diseases. The goal was to assess the benefit of GMV in patients diagnosed with Fibromyalgia (FM). <h3>Objectives</h3> We conducted a pilot study to assess the benefits of group medical visits (GMV) among patients with Fibromyalgia. Our primary objective was to improve outcomes by educating patients and demonstrating five integrative techniques: breath work, journaling, mindfulness, movement, and nutrition. <h3>Methods</h3> Patients diagnosed with Fibromyalgia participated in a series of group appointments. The four consecutive monthly sessions included: (1) an introduction to the series and demonstration of breathing techniques and journaling; (2) a presentation of the benefits of movement and participation in Tai Chi session; (3) an overview to mindfulness and guided meditation; (4) a discussion regarding the biosome, nutrition, and elimination diets. Our clinical outcome measures included: The Fibromyalgia Impact Questionnaire (FIQ score), Personal Health Questionnaire Depression Scale (PHQ8) and Multi-Dimensional Health Assessment (MDHAQ). We took measurements at baseline and following completion of the last appointment. Our analysis consisted of a paired t-test to determine whether the mean difference between the baseline and follow-up outcomes was statistically significant. <h3>Results</h3> The average baseline and follow up measures were as follows: FIQ 61.5 to 50.3(CI -15.8 - 4.3, p-value 0.0011), PHQ8 10.7 to 6.5 (CI -5.8 - -2.1, p-value 0.0001) and MDHAQ 16.4 to 13.59(CI -4.9 - -1.5, p-value 0.0006), respectively. All measurements were statistically significant. <h3>Conclusion</h3> Our findings suggest that group medical visits are a valuable, beneficial, efficacious and cost-effective way to deliver care and information to patients with fibromyalgia. GMV's facilitate education, provide social support and most importantly, improved clinical outcomes. <h3>References:</h3> [1] Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160-72. doi: 10.1002/art.1780330203. PMID: 2306288 [2] Bernik M, Sampaio TP, Gandarela L. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep. 2013 Sep;17(9):358. doi: 10.1007/s11916-013-0358-3. PMID: 23904203. [3] Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017 Feb;76(2):318-328. doi: 10.1136/annrheumdis-2016-209724. Epub 2016 Jul 4. PMID: 27377815. [4] Lestoquoy AS, Laird LD, Mitchell S, et al. Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies. <i>Complement Ther Med</i>. 2017;35:33-38. doi:10.1016/j.ctim.2017.09.002 [5] Gardiner P, Luo M, D'Amico S, et al. Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial. <i>PLoS One</i>. 2019;14(12):e0225540. Published 2019 Dec 18. doi:10.1371/journal.pone.0225540 <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Jose A. Pando Speakers bureau: Sanofi. Abbie. Lilly, Catherine Welton: None declared, Susan Griffith: None declared, Oriana Pando: None declared.